title: Optimal in-hospital and discharge medical therapy in acute coronary syndromes in Kerala: results from the Kerala acute coronary syndrome registry.
abstract: BACKGROUND
  In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25,718 admissions.
  
  
  RESULTS
  We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications: aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student t test for continuous variables and χ(2) test for categorical variables. We created random effects logistic regression models to evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions, respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching consistently high (>90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95% confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79 (0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]).
  
  
  CONCLUSIONS
  Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care measures and ACS outcomes in Kerala.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. m-huffman@northwestern.edu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.forename: Adangapuram Kurien
authors.initials: AK
authors.lastname: Abraham
authors.forename: Mangalath Narayanan
authors.initials: MN
authors.lastname: Krishnan
authors.forename: Asokan Cheviri
authors.initials: AC
authors.lastname: Nambiar
authors.forename: Padinhare Purayil
authors.initials: PP
authors.lastname: Mohanan
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D016507:Cardiology Service, Hospital / Q000592:standards*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007194:India; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: acute coronary syndrome; health policy and outcome research; registries